This report describes the latest concepts of pathomechanisms of pain as
a basis for management and development of new pharmacotherapies for
pain. Major segments of the pain market are arthritis, neuropathic pain
and cancer pain. Because pain is a subjective sensation, it is difficult
to evaluate objectively in clinical trials. Various tools for pain
measurement are described, including brain imaging.

The wide variety of drugs in development includes opioid receptor
ligands, bradykinin antagonists, mPGES-1 inhibitors, glutamate receptor
antagonists, substance P and neurokinin receptor antagonists,
norepinephrine transporter inhibitors,P2X2 neuron receptor antagonists
and nitric oxide-based analesics. A number of cannabinoids are also in
development for pain. Fish-derived tetrodotoxin was initially focused on
indication of opiate addiction withdrawal but is found to have an
analgesic action as well. Cone shells contain therapeutically useful
peptides including the conotoxins, and one such peptide, ziconotide, has
been approved. Various cell and gene therapies are also being developed
for the management of pain.

Advances in molecular and biological techniques are markedly advancing
our understanding of pain. Understanding the pathophysiology of pain is
an important factor in discovery of rational therapies for pain.
Advances in pharmacogenomics and pharmacogenetics are enabling the
development of personalized approaches to the management of pain.

Over 500 companies have been identified to be involved in developing or
marketing pain therapeutics and 175 of these are profiled in the report
along with 151 collaborations. These are a mix of pharmaceutical
companies and biotechnology companies.

The worldwide analgesic markets were analyzed for the year 2013 and
projected to 2023. Calculations are based on the epidemiology of various
painful conditions and the development of analgesic drugs and devices.
Unfulfilled needs for analgesics are identified and strategies are
outlined to develop markets for analgesic drugs. The report is
supplemented with 71 tables, 22 figures, and 600 selected references to
the literature.